Jack Larry Wisdom, CSA
NPI #1376968750 in Paradise, California
Provider Information
- NPI Number
- 1376968750
- Entity Type
- Individual
- Name
- Jack Larry Wisdom, CSA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Registered Nurse
- Credential
- CSA
- Enumeration Date
- Feb 21, 2014
- Last Updated
- Feb 21, 2014
Practice Location
- Address
- 5974 PENTZ RD
- City
- Paradise
- State
- California
- ZIP Code
- 95969-5509
- Phone
- (530) 876-7903
Specialties & Taxonomy Codes
| Specialty |
|---|
| Registered Nurse |
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